II. Epidemiology
-
Incidence
- Worldwide: 155 million cases annually (and 2 million deaths under age 5 years)
III. Causes
- See Pneumonia Causes in Children
- Viral Pneumonia accounts for 80% of cases in under age 2 year old children
IV. History
- Age suggests cause and management
- Immunizations deficient
- Recent hospitalizations
- Day care attendance
- Contagious contacts
- Travel
- Influenza
- Severe Acute Respiratory Syndrome (Asia)
- Fungal Infection
- Blastomycosis
- Coccidioidomycosis (Southwestern U.S.)
- Histoplasmosis (Ohio and Mississippi River Valleys)
- Recent antibiotics
- Consider Antibiotic Resistance (e.g. PRP)
- Comorbid conditions
- Cardiopulmonary disease (e.g. Cystic Fibrosis)
- Immunodeficiency (e.g. Asplenic)
- Neuromuscular Disease
- Possible Ingestion
V. Risk Factors
- Young age
- Male gender
- Tobacco exposure
- Pollution exposure
- Child care attendance
- Malnutrition
- Immunodeficiency
- Anatomical airway anomalies
- Underlying metabolic disorders
VI. Precautions
- Occult Pneumonia should be considered in the following cases
- Fever for more than 5 days (especially if over 39 C)
- Leukocytosis with White Blood Cell Count over 20,000
- Abdominal Pain (more common presentation in age under 5 years)
VII. Symptoms
- Respiratory symptoms (see signs below)
- Lethargy
- Irritability
- Decreased oral intake
- Dehydration (e.g. decreased Urine Output)
- Vomiting
- Diarrhea
- Abdominal Pain
VIII. Signs
-
Pneumonia unlikely without fever and Tachypnea
- Consider Chlamydia trachomatisPneumonia in under age 3 weeks if affebrile with Staccato Cough
- Consider Mycoplasma pneumonia in older children with malaise, Sore Throat, fever and indolent course
- Findings highly suggestive of Pneumonia
- Fever
- More commonly >101.3 F in Bacterial Pneumonia
- Cyanosis
- Respiratory distress (one or more of the following)
- Respiratory Distress in Children with Pneumonia
- Tachypnea
- Absence of tachpnea when fever is present has strong Negative Predictive Value
- Tachypnea is common with fever and therefore has poor Positive Predictive Value
- Cough
- Nasal flaring
- Intercostal retractions
- Grunting
- Rales
- Decreased breath sounds
- Fever
IX. Differential Diagnosis
- See Pneumonia
- Head and neck disorders
- Respiratory conditions
X. Labs: Efficacy
- Tests that are helpful
- Rapid viral Antigens
- Influenza Immunoassay
- RSV Test
- Not indicated in classic presentations (obtain if unclear diagnosis)
- Oxygen Saturation (if respiratory distress)
- Rapid viral Antigens
- Tests helpful in severe cases (low yield if moderate)
- Tests possibly useful in retrospect (identify outbreak)
- Mycoplasma pneumoniae titer
- Chlamydia pneumoniae titer
- Tests which are usually not helpful for diagnosis
- Complete Blood Count (CBC)
- C-Reactive Protein (CRP)
- Erythrocyte Sedimentation Rate (ESR)
XI. Labs: Inpatient
- Influenza test
- RSV test
- Sputum Culture and Gram Stain
- Blood Culture and Gram Stain
- Complete Blood Count
- C-Reactive Protein (CRP)
- Erythrocyte Sedimentation Rate (ESR)
XII. Imaging: Chest XRay
- Indications
- Findings
- Lobar consolidation
- More common in Bacterial Pneumonia
- May be seen in viral pneumona
- Interstitial Infiltrates
- More common in Viral Pneumonia
- May be seen in Bacterial Pneumonia
- Lobar consolidation
- Precautions
- Chest XRay does not differentiate virus from Bacteria
- Chest XRay may be normal in early Pneumonia
- Chest XRay may be abnormal for 3-6 weeks after diagnosis
XIII. Management
XIV. Disposition
XV. Complications: Parapneumonic Effusion
- See Pneumonia for other complications
- Indications for drainage
- Symptomatic
- Pleural Effusions >10 mm on lateral XRay
- Pleural Effusion >1/4 of hemithorax
XVI. Prevention: Immunization: Primary Series
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Related Studies
Definition (MSH) | Inflammation of any part, segment or lobe, of the lung parenchyma. |
Definition (MEDLINEPLUS) |
Pneumonia is an infection in one or both of the lungs. Many germs, such as bacteria, viruses, and fungi, can cause pneumonia. You can also get pneumonia by inhaling a liquid or chemical. People most at risk are older than 65 or younger than 2 years of age, or already have health problems. Symptoms of pneumonia vary from mild to severe. See your doctor promptly if you
Your doctor will use your medical history, a physical exam, and lab tests to diagnose pneumonia. Treatment depends on what kind you have. If bacteria are the cause, antibiotics should help. If you have viral pneumonia, your doctor may prescribe an antiviral medicine to treat it. Preventing pneumonia is always better than treating it. Vaccines are available to prevent pneumococcal pneumonia and the flu. Other preventive measures include washing your hands frequently and not smoking. NIH: National Heart, Lung, and Blood Institute |
Definition (NCI_NCI-GLOSS) | A severe inflammation of the lungs in which the alveoli (tiny air sacs) are filled with fluid. This may cause a decrease in the amount of oxygen that blood can absorb from air breathed into the lung. Pneumonia is usually caused by infection but may also be caused by radiation therapy, allergy, or irritation of lung tissue by inhaled substances. It may involve part or all of the lungs. |
Definition (NCI) | An acute, acute and chronic, or chronic inflammation focally or diffusely affecting the lung parenchyma, due to infections (viruses, fungi, mycoplasma, or bacteria), treatment (e.g. radiation), or exposure (inhalation) to chemicals. Symptoms include cough, shortness of breath, fevers, chills, chest pain, headache, sweating, and weakness. |
Definition (CSP) | inflammation of the lungs with consolidation and exudation. |
Concepts | Disease or Syndrome (T047) |
MSH | D011014 |
ICD10 | J18.9 |
SnomedCT | 274103002, 155552002, 155558003, 266391003, 155548002, 60363000, 205237003, 233604007 |
LNC | LP21407-9, MTHU020831, LA7465-3 |
English | Pneumonitis, Pneumonia, Pneumonias, Pneumonia, unspecified, Pneumonitides, Pneumonia NOS, pneumonia (diagnosis), pneumonia, Pneumonitis NOS, Pneumonia [Disease/Finding], Pneumoniae, inflammation lungs, unspecified pneumonia, pneum, pulmonary inflammation, lung inflammation, Inflammation, Lung, Inflammation, Pulmonary, Inflammations, Lung, Inflammations, Pulmonary, Lung Inflammation, Lung Inflammations, Pulmonary Inflammation, Pulmonary Inflammations, Pneumonia NOS (disorder), Pulmonary inflammation, Lung inflamed, Pulmonitis, PNEUMONIA, Pneumonia (disorder), Pneumonia, NOS, Pneumonia (disorder) [Ambiguous], pneumonitis |
French | PNEUMONIE, Congestion pulmonaire SAI, Pneumonite, Pneumonie SAI, Pneumopathie infectieuse, Pneumonie |
Portuguese | PNEUMONIA, Pneumonite NE, Pulmonite, Pneumonia NE, Pulmonia, Pneumonia, Inflamação do Pulmão, Inflamação Pulmonar, Pneumonite |
Spanish | NEUMONIA, Neumonitis NEOM, Neumonía NEOM, neumonia, SAI (trastorno), Pneumonia NOS, neumonia, SAI, Pneumonía, Pulmonía, neumonía (concepto no activo), neumonía (trastorno), neumonía, Neumonitis, Inflamación del Pulmón, Inflamación Pulmonar, Neumonía |
German | PNEUMONIE, Pneumonie NNB, Pulmonitis, Pneumonitis NNB, Pneumonie, nicht naeher bezeichnet, Lungenentzuendung, Pneumonie, Pneumonitis, Lungenentzündung |
Italian | Infezione polmonare, Polmonite aspecifica, Infezione dei polmoni, Infezione polmonare aspecifica, Pneumonite, Infiammazione del polmone, Infiammazione polmonare, Polmonite |
Dutch | pneumonie NAO, pneumonitis NAO, pulmonitis, Pneumonie, niet gespecificeerd, pneumonie, Pneumonie, Longontsteking, Pneumonitis |
Japanese | 肺炎NOS, 肺臓炎, 肺臓炎NOS, ハイエンNOS, ハイエン, ハイゾウエンNOS, ハイゾウエン, 肺炎 |
Swedish | Lunginflammation |
Czech | pneumonie, Pneumonie, Pulmonitida, Pneumonie NOS, Pneumonitida NOS, zápal plic, zánět plic |
Finnish | Keuhkokuume |
Russian | PNEVMONIIA, ПНЕВМОНИЯ |
Korean | 상세불명의 폐렴 |
Croatian | PNEUMONIJA |
Polish | Zapalenie płuc |
Hungarian | pneumonia, Pneumonitis k.m.n., pneumonia k.m.n., Pulmonitis |
Norwegian | Pneumoni, Lungebetennelse |